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ICD-10 Guide
ICD-10 CodesI42.7

I42.7

Billable

Cardiomyopathy due to drug and external agent

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/06/2025

Code Description

ICD-10 I42.7 is a billable code used to indicate a diagnosis of cardiomyopathy due to drug and external agent.

Key Diagnostic Point:

I42.7 refers to cardiomyopathy due to drug and external agents, a condition characterized by the deterioration of the heart muscle, which can lead to heart failure and other serious complications. This type of cardiomyopathy can result from various substances, including certain medications (e.g., chemotherapy agents, alcohol) and environmental toxins. Clinically, patients may present with symptoms such as fatigue, shortness of breath, palpitations, and edema. The anatomy involved primarily includes the myocardium, which is the muscular layer of the heart responsible for contraction. Disease progression can vary; some patients may experience acute symptoms following exposure to the offending agent, while others may develop chronic heart dysfunction over time. Diagnostic considerations include a thorough patient history to identify potential exposures, echocardiography to assess heart function, and possibly cardiac MRI or biopsy in complex cases. Laboratory tests may also be necessary to rule out other causes of heart failure.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires detailed patient history and potential toxicology screening.
  • Treatment complexity: Management may involve discontinuation of the offending agent and symptomatic treatment.
  • Documentation requirements: Comprehensive documentation of exposure history and clinical findings is essential.
  • Coding specificity: Requires accurate identification of the causative agent for proper coding.

Audit Risk Factors

  • Common coding errors: Misidentifying the cause of cardiomyopathy or failing to document the specific agent.
  • Documentation gaps: Incomplete patient history regarding drug use or exposure to toxins.
  • Billing challenges: Potential denials if documentation does not clearly support the diagnosis.

Specialty Focus

Medical Specialties

Cardiology

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Toxicology

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Related ICD-10 Codes

Related CPT Codes

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical significance of I42.7 lies in its potential to lead to severe heart dysfunction and increased morbidity. Understanding the impact of drug-induced cardiomyopathy is crucial for population health, as it highlights the need for monitoring patients on high-risk medications. Quality measures may include tracking the incidence of drug-related cardiomyopathy and ensuring appropriate screening and management strategies are in place. Epidemiologically, awareness of this condition can inform public health initiatives aimed at reducing exposure to harmful substances.

ICD-9 vs ICD-10

The clinical significance of I42.7 lies in its potential to lead to severe heart dysfunction and increased morbidity. Understanding the impact of drug-induced cardiomyopathy is crucial for population health, as it highlights the need for monitoring patients on high-risk medications. Quality measures may include tracking the incidence of drug-related cardiomyopathy and ensuring appropriate screening and management strategies are in place. Epidemiologically, awareness of this condition can inform public health initiatives aimed at reducing exposure to harmful substances.

Reimbursement & Billing Impact

reimbursement.

Resources

Clinical References

  • •
    ICD-10 Official Guidelines for I00-I99
  • •
    Clinical Documentation Requirements

Coding & Billing References

  • •
    ICD-10 Official Guidelines for I00-I99
  • •
    Clinical Documentation Requirements

Frequently Asked Questions

What specific conditions are covered by I42.7?

I42.7 covers cardiomyopathy resulting from exposure to drugs, including chemotherapeutic agents, alcohol, and certain recreational drugs, as well as environmental toxins. It is essential to document the specific agent involved to support the diagnosis.

When should I42.7 be used instead of related codes?

I42.7 should be used when there is clear evidence of cardiomyopathy directly linked to a drug or external agent. If the cardiomyopathy is idiopathic or due to other causes, different codes should be considered.

What documentation supports I42.7?

Documentation should include a detailed patient history of drug use or exposure to toxins, clinical findings consistent with cardiomyopathy, and any relevant diagnostic tests that confirm the diagnosis.